'Oumuamua Is Not a Probe Sent to Our Solar System by an Alien Civilization

'Oumuamua, the first known object of extrasolar origin seen to enter our Solar System, has multiple unusual characteristics that, taken together, are very difficult to explain with conventional astronomical entities like asteroids and comets. Consequently, it has been hypothesized that 'Oumuamua is an interstellar probe that was constructed by an alien civilization. We demonstrate that the accomplishments that can be achieved with large space telescopes/interferometers in the alien's planetary system will completely quench any motivation for construction and launch of an 'Oumuamua-like probe. The absence of any such motivation attests that 'Oumuamua is not an alien creation. The existence of large space telescopes has important implications for a range of topics that include interstellar space travel, the Zoo Hypothesis, METI, and UFOs.

A giant planet candidate transiting a white dwarf

Astronomers have discovered thousands of planets outside the Solar System¹, most of which orbit stars that will eventually evolve into red giants and then into white dwarfs. During the red giant phase, any close-orbiting planets will be engulfed by the star², but more distant planets can survive this phase and remain in orbit around the white dwarf^3,4. Some white dwarfs show evidence for rocky material floating in their atmospheres⁵, in warm debris disks^6-9 or orbiting very closely^10-12, which has been interpreted as the debris of rocky planets that were scattered inwards and tidally disrupted¹³. Recently, the discovery of a gaseous debris disk with a composition similar to that of ice giant planets¹⁴ demonstrated that massive planets might also find their way into tight orbits around white dwarfs, but it is unclear whether these planets can survive the journey. So far, no intact planets have been detected in close orbits around white dwarfs. Here we report the observation of a giant planet candidate transiting the white dwarf WD 1856+534 (TIC 267574918) every 1.4 days. We observed and modelled the periodic dimming of the white dwarf caused by the planet candidate passing in front of the star in its orbit. The planet candidate is roughly the same size as Jupiter and is no more than 14 times as massive (with 95 per cent confidence). Other cases of white dwarfs with close brown dwarf or stellar companions are explained as the consequence of common-envelope evolution, wherein the original orbit is enveloped during the red giant phase and shrinks owing to friction. In this case, however, the long orbital period (compared with other white dwarfs with close brown dwarf or stellar companions) and low mass of the planet candidate make common-envelope evolution less likely. Instead, our findings for the WD 1856+534 system indicate that giant planets can be scattered into tight orbits without being tidally disrupted, motivating the search for smaller transiting planets around white dwarfs.

Oxygen fugacities of extrasolar rocks: Evidence for an Earth-like geochemistry of exoplanets

Oxygen fugacity is a measure of rock oxidation that influences planetary structure and evolution. Most rocky bodies in the Solar System formed at oxygen fugacities approximately five orders of magnitude higher than a hydrogen-rich gas of solar composition. It is unclear whether this oxidation of rocks in the Solar System is typical among other planetary systems. We exploit the elemental abundances observed in six white dwarfs polluted by the accretion of rocky bodies to determine the fraction of oxidized iron in those extrasolar rocky bodies and therefore their oxygen fugacities. The results are consistent with the oxygen fugacities of Earth, Mars, and typical asteroids in the Solar System, suggesting that at least some rocky exoplanets are geophysically and geochemically similar to Earth.

Extreme collisions between planetesimals as the origin of warm dust around a Sun-like star

The slow but persistent collisions between asteroids in our Solar System generate a tenuous cloud of dust known as the zodiacal light (because of the light the dust reflects). In the young Solar System, such collisions were more common and the dust production rate should have been many times larger. Yet copious dust in the zodiacal region around stars much younger than the Sun has rarely been found. Dust is known to orbit around several hundred main-sequence stars, but this dust is cold and comes from a Kuiper-belt analogous region out beyond the orbit of Neptune. Despite many searches, only a few main-sequence stars reveal warm (> 120 K) dust analogous to zodiacal dust near the Earth. Signs of planet formation (in the form of collisions between bodies) in the regions of stars corresponding to the orbits of the terrestrial planets in our Solar System have therefore been elusive. Here we report an exceptionally large amount of warm, small, silicate dust particles around the solar-type star BD+20,307 (HIP 8920, SAO 75016). The composition and quantity of dust could be explained by recent frequent or huge collisions between asteroids or other 'planetesimals' whose orbits are being perturbed by a nearby planet.

Preschool child care and risk of overweight in 6- to 12-year-old children

OBJECTIVE

To determine if there is a relationship between center-based child care attendance from ages 3 to 5 y and future overweight at ages 6-12 y.

DESIGN/METHODS

Longitudinal, observational study of child experience and future body mass index.

SUBJECTS

A total of 1244 US children aged 6-12 y included in the 1997 Panel Study of Income Dynamics Child Development Supplement.

MEASUREMENTS

Parent-reported child care attendance from ages 3 to 5 y, trichotomized as 'none', 'limited' (>0 but <15 h/week), and 'extensive' (> or =15 h/week). Overweight defined as a body mass index > or =95th percentile for age and gender. Candidate covariates (selected a priori): gender, race, age, poverty status, birth weight, hours of television per day, Behavior Problems Index score >90th percentile, and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score.

RESULTS

Of the potential confounding variables, race, HOME-SF cognitive stimulation score, and age significantly altered the relationship between child care attendance and overweight in the multiple logistic regression model. With these covariates in the final model, limited center-based child care attendance from ages 3 to 5 y was independently associated with a decreased risk of overweight at ages 6-12 y (adjusted odds ratio=0.56, 95% confidence interval 0.34, 0.93) relative to no child care attendance. Extensive center-based child care attendance was not associated with future overweight.

CONCLUSIONS

Limited center-based child care attendance during the preschool years was independently associated with a decreased risk of future overweight relative to no child care attendance. Additional studies are needed to clarify these findings.

Puerperal adrenal abscess complicating chorioamnionitis

BACKGROUND

An abscess in the adrenal gland is a rare finding described only a few times in the literature. We present a case report of chorioamnionitis complicated by a puerperal adrenal abscess diagnosed and drained percutaneously using ultrasound and computed tomography.

CASE

A 22-year-old woman delivered prematurely because of chorioamnionitis. Amoxicillin clavulanate was administered, and her fever defervesced. Six days later, the patient presented with a temperature of 40C and right flank pain. Workup revealed an abscess in the right adrenal gland, which was diagnosed by computed tomography scan, and then drained percutaneously. Follow-up revealed regression of the abscess to complete recovery.

CONCLUSION

Adrenal abscess has not been described in the past as a possible complication of choriamnionitis. It is important to assess the entire abdominal cavity by ultrasound or computed tomography in febrile patients who do not respond to medical therapy.

Molecular epidemiology of preterm delivery: methodology and challenges

Preterm delivery (PTD) appears to be a complex trait determined by both genetic and environmental factors. Few studies have examined genetic influence on PTD. The overall goal of our study is to examine major candidate genes of PTD and to test gene-environment interactions. Our study includes 500 preterm trios, including 500 preterm babies and their parents and 500 maternal age-matched term controls. We will perform the transmission/disequilibrium test (TDT) on candidate genes thought to be important in each of the four biological pathways of PTD: (1) decidual chorioamionotic inflammation: interleukin 1 (IL-1), IL-6, and tumour necrosis factor (TNF); (2) maternal and fetal stress: corticotropin-releasing hormone (CRH); (3) uteroplacental vascular lesions: methylenetereahydrofolate reductase (MTHFR); and (4) susceptibility to environmental toxins: GSTM1, GSTT1, CYP1A1, CYP2D6, CYP2E1, NAT2, NQO1, ALDH2, and EPHX. We will also perform standard case-control analyses on the 500 preterm cases and 500 term controls to examine gene-environment interactions. The major environmental, nutritional and social factors as well as clinical variables known or suspected to be associated with PTD will be used to test for gene-environment interactions. This study integrates epidemiological and clinical data as well as genetic markers along major pathogenic pathways of PTD. The findings from this study should improve our understanding of genetic influences on PTD and gene-environment interactions.

Growth, development, and behavior in early childhood following prenatal cocaine exposure: a systematic review

CONTEXT

Despite recent studies that failed to show catastrophic effects of prenatal cocaine exposure, popular attitudes and public policies still reflect the belief that cocaine is a uniquely dangerous teratogen.

OBJECTIVE

To critically review outcomes in early childhood after prenatal cocaine exposure in 5 domains: physical growth; cognition; language skills; motor skills; and behavior, attention, affect, and neurophysiology.

DATA SOURCES

Search of MEDLINE and Psychological Abstracts from 1984 to October 2000.

STUDY SELECTION

Studies selected for detailed review (1) were published in a peer-reviewed English-language journal; (2) included a comparison group; (3) recruited samples prospectively in the perinatal period; (4) used masked assessment; and (5) did not include a substantial proportion of subjects exposed in utero to opiates, amphetamines, phencyclidine, or maternal human immunodeficiency virus infection.

DATA EXTRACTION

Thirty-six of 74 articles met criteria and were reviewed by 3 authors. Disagreements were resolved by consensus.

DATA SYNTHESIS

After controlling for confounders, there was no consistent negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optimal motor scores have been found up to age 7 months but not thereafter, and may reflect heavy tobacco exposure. No independent cocaine effects have been shown on standardized parent and teacher reports of child behavior scored by accepted criteria. Experimental paradigms and novel statistical manipulations of standard instruments suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affective findings.

CONCLUSIONS

Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child's environment. Further replication is required of preliminary neurologic findings.

A mediational model for the impact of exposure to community violence on early child behavior problems

This study examined how maternal distress mediates the link between exposure to community violence (CV) and the development of early child behavior problems. Research was conducted among 160 children, 3,0 to 5,11 in age, who resided in high-crime neighborhoods. Using structural equation modeling, latent variables were constructed to identify model components: maternal socioeconomic status (SES) and public assistance status, exposure to CV (maternal perceptions of local violence, social disorder, and fear of crime; and frequency of child cowitnessing violent events), family aggression (partner aggression toward mother and partner aggression toward child), maternal distress (global distress and posttraumatic stress disorder symptoms), and early child behavior problems (internalizing and externalizing). Bivariate correlations indicated that CV, maternal distress, and early child behavior problems were significantly intercorrelated. A series of structural equation models was specified to estimate the direct and indirect effect of CV on early child behavior problems. A direct model indicated a significant path from CV to early child behavior problems, after controlling for maternal SES and family aggression. The direct CV-early child behavior problems path diminished, however, when maternal distress was included in the model, after controlling for maternal SES and family aggression. Results are consistent with a mediation model of the impact of maternal distress symptoms on the link between CV and early child behavior problems.

An evaluation of I Can Cope. Insights into program design and implementation

The I Can Cope program is an educational program developed to provide information on how to promote physical and emotional well-being to individuals with cancer, their families, and friends. Through focus group and individual interviews and a mailed survey, the effectiveness of the selection, marketing, implementation, and support processes associated with implementing the program in the central Arizona and greater Las Vegas, Nevada, regions was evaluated. Findings, recommendations, lessons learned, and use of findings are discussed.

A public health response to emerging technology: expansion of the Massachusetts newborn screening program

The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged governments worldwide to consider expanding universal newborn screening for rare metabolic disorders. In 1997 the Massachusetts Department of Public Health developed a public process to meet this challenge. After addressing significant medical, legal, ethical, and logistical issues raised by tandem MS, Massachusetts incorporated one new disorder into the mandatory newborn screen and developed an optional pilot program for 20 additional disorders. The Massachusetts experience has wide relevance for other nations and states. As screening protocols are contemplated for entire populations-for newborns and others- it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.

Genetic susceptibility to benzene and shortened gestation: evidence of gene-environment interaction

This study investigated whether the association between low level benzene exposure and shortened gestation is modified by two susceptibility genes, CYP1A1 and GSTT1. This report includes 542 (302 nonexposed, 240 benzene-exposed) nonsmoking and nondrinking mothers of singleton live births at Beijing Yanshan Petrochemical Corporation between June 1995 and June 1997. Epidemiologic and clinical data and blood samples were obtained from mothers. Multiple linear regression models were used to estimate the associations of benzene exposure and genetic susceptibility with gestational age, adjusting for maternal age, education, parity, stress, passive smoking, prepregnancy weight and height, and infant's sex. Without consideration of genotype, benzene exposure was associated with a decrease in mean gestational age of 0.29 (standard error (SE), 0.12) week. When stratified by the maternal CYP1A1 genotype, the estimated decrease was 0.54 (SE, 0.12) week for the AA group, which was significantly greater (p = 0.003) than that for the Aa/aa group, which showed no decrease in gestational age. When both CYP1A1 and GSTT1 were considered, the greatest decrease was found among exposed mothers with the CYP1A1 AA-GSTT1 absent group (0.79 (SE, 0.25) week) and the CYP1A1 AA-GSTT1 present group (0.50 (SE, 0.22) week). Among the nonexposed, genetic susceptibility alone did not confer a significant adverse effect. This study provides evidence of gene-environment interaction and supports further assessment of the role of genetic susceptibility in the evaluation of reproductive toxins.

Brown dwarfs: at last filling the gap between stars and planets

Until the mid-1990s a person could not point to any celestial object and say with assurance that "here is a brown dwarf." Now dozens are known, and the study of brown dwarfs has come of age, touching upon major issues in astrophysics, including the nature of dark matter, the properties of substellar objects, and the origin of binary stars and planetary systems.

[Vaginal vault prolapse: repair by sacrospinous ligament fixation]

Sacrospinous ligament fixation is a well-known method for correction of vaginal vault prolapse. The procedure is primarily indicated after hysterectomy and as a prophylactic measure for total uterine prolapse. 8 women with post-hysterectomy vaginal vault prolapse aged 48-72 years, were referred 1-25 years following primary surgery. Sacrospinous ligament fixation was elected to enable simultaneous correction of cystocele and rectocele, and to preserve sexual function. All operations were completed without significant complications. In 6 of the 8 patients located for long-term interview, 1 reported mild bulging of the introitus, another mild urinary stress incontinence, urgency and frequency and 1 reported frequency only. Sexual function in 4 was without complaints. Defecation in all patients was normal. We conclude that this operation is safe and effective. We encourage gynecologic surgeons to consult an experienced tutor prior to performing this procedure, as this type of surgery is quite dangerous and many gynecologists are not familiar enough with it.

The Circumstellar Disk of HD 141569 Imaged with NICMOS

Coronagraphic imaging with the Near-Infrared Camera and Multiobject Spectrometer on the Hubble Space Telescope reveals a large, approximately 400 AU (4&arcsec;) radius, circumstellar disk around the Herbig Ae/Be star HD 141569. A reflected light image at 1.1 µm shows the disk oriented at a position angle of 356&j0;+/-5&j0; and inclined to our line of sight by 51&j0;+/-3&j0;; the intrinsic scattering function of the dust in the disk makes the side inclined toward us, the eastern side, brighter. The disk flux density peaks 185 AU (1&farcs;85) from the star and falls off to both larger and smaller radii. A region of depleted material, or a gap, in the disk is centered 250 AU from the star. The dynamical effect of one or more planets may be necessary to explain this morphology.

Level of in utero cocaine exposure and neonatal ultrasound findings

OBJECTIVE

To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables.

STUDY DESIGN

In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group.

RESULTS

Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35).

CONCLUSIONS

This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.

[Tension-free vaginal tape--a new surgical treatment of female urinary stress incontinence]

Female urinary stress incontinence diminishes the quality of life of about 5% of women. It is usually dealt with by surgery to correct the relaxed pelvic floor, the cause of the incontinence. Tension-free vaginal tape is used in a newly described procedure. It consists of the vaginal introduction of a prolene needle-guided mid-urethral sling. The procedure is easy to perform under local anesthesia, recovery is rapid, and results are similar to those of other effective operations. We report 44 patients who underwent this type of surgery. There were no significant complications. The early results were good and although the follow-up has been short, we believe that experience with this operation will play an important role in the treatment of urinary stress incontinence.

Restraining orders: a frequent marker of adverse maternal health

OBJECTIVE

Women with histories of interpersonal violence are poorly identified because of barriers in self-disclosure. This study identified differences on maternal health and child behavior between women who report filing a restraining order (RO) and those who do not among a nonreferred sample of women living in high-crime neighborhoods.

METHODS

During a maternal interview mothers were asked whether they ever filed a RO, the victim/defendant relationship, the number of times, and the year of the filing. Four types of violence were coded independently based on maternal narratives: verbal harassment, verbal threats or intimidation, physical assault, and destruction of property. We controlled for differences between RO and non-RO groups regarding demographic background, partner characteristics, other types of maternal past victimization, and use of alcohol and illicit drugs. Outcomes for mothers include partner aggression (Conflict Tactics Scale-R), perception of health and bodily pain (SF-36 Health Survey), distress symptoms (SCL90-R), posttraumatic stress (PTS)-related symptoms, and partial posttraumatic stress disorder (PTSD) diagnosis (modified Diagnostic Interview Schedule PTSD-Module). Outcomes for the child include partner aggression (Conflict Tactic Scale-R), behavior problems (CBC 2-3 or Child Behavior Checklist), and PTS-related symptoms (PTS-related symptom checklist).

PATIENTS

One hundred sixty patients between 3.0 to 6.1 years who resided within five residential ZIP codes with a high rate of local crime in the City of Boston were drawn from a pediatric care clinic practice. Patients were participants of a larger study about the impact of community violence on mother-child relations.

RESULTS

Sixty-four (40%) of 160 mothers reported a history of filing a RO against a current boyfriend or husband (39%), ex-boyfriend or husband (44%), someone known (8%), or other (9%), with a mean of 3.9 years (standard deviation = 3.5 years) since RO filing. After controlling for covariates of marital status, immigrant status, public assistance, and lifetime sexual victimization, we found a significant multivariate analysis of covariance group effect on maternal outcomes. Analysis of covariance analyses indicated that mothers in the RO group experienced higher current partner verbal aggression and physical violence to mother, poorer health, and higher PTS-related symptoms, compared with mothers in the non-RO group. More mothers in the RO group met partial lifetime PTSD diagnosis. Unadjusted for maternal covariates, the multivariate analysis of variance analyses on child outcomes (partner aggression to child, behavior problems, and PTS-related symptoms) indicated a nonsignificant group effect.

CONCLUSIONS

Among dyads residing in high-risk crime areas, the incidence of RO histories is substantive considering this was a nonshelter, nonreferred sample. The inquiry about the history of a RO may provide a new and efficient marker to quality of current partner relationship, maternal health, and maternal stress-related symptomatology.

Familial aggregation of blood pressure in a rural Chinese community

This study investigated blood pressure in 1,183 Chinese nuclear families (mother, father, and first two children) via a cross-sectional 1994-1997 survey. The mother's, the father's, and the first sibling's blood pressures were each significantly and independently related to the second sibling's blood pressure after adjustment for sex, age, height, weight, education, smoking, and alcohol consumption. The association was consistent across the four age strata (6-10, 11-14, 15-19, and > or = 20 years). The rate of high systolic blood pressure in the second sibling was lowest (2.3%) when both parents and the first sibling were in the low blood pressure tertile (low-low group) and highest (26.0%) when these family members were in the high blood pressure tertile (high-high group). The rate was intermediate if only the parents (10.7%, high-low group) or the first sibling (8.4%, low-high group) was in the high blood pressure tertile. As compared with the low-low group, the odds ratios for the high-high, high-low, and low-high groups were 14.3 (95% confidence interval 4.3-48.2), 4.3 (95% confidence interval 1.2-15.6), and 3.9 (95% confidence interval 1.1-14.4), respectively. A similar pattern was found for diastolic blood pressure. The data indicate a strong familial aggregation of blood pressure in this population and show that such a familial influence on blood pressure can be detected from early childhood onward.

Blood pressure in children exposed prenatally to cocaine

Prenatal exposure to cocaine may alter autonomic nervous system function resulting in hypertension. Blood pressure was measured oscillometrically in a convenience sample of cocaine-exposed (n = 32) and nonexposed (n = 23) children, aged 8 to 26 months, by examiners unaware of exposure status. The exposed and nonexposed groups did not differ in systolic pressure (mean +/- SD 102.3 +/- 9.9 mmHg vs 119.1 +/- 19.4). Prenatal exposure to cocaine does not appear to be associated with elevated blood pressure in young children.

Blood pressure at age 3-24 years in a rural community in Anhui, China

PURPOSE

This community-based study in Anhui, China examined the sex-specific pattern of blood pressure (BP) and its major determinants between age 3 and 24 years.

METHODS

BP, height, weight, and related covariates were obtained from all eligible subjects by consistent methods. A generalized additive model was used to explore independent relations between BP and covariates. The sample for analyses included a total of 14,277 subjects (7244 males and 7033 females).

RESULTS

Systolic blood pressure (SBP) increased linearly with age to an apparent plateau around the age of 15 years in girls and 20 years in boys. Diastolic blood pressure (DBP) essentially paralleled SBP. Until the age of 10, both SBP and DBP were similar in boys and girls; thereafter, values for boys surpassed those for girls with an average difference of 9 mmHg and 4 mmHg for SBP and DBP, respectively, at 20 years of age. This sex difference appeared to persist into early adulthood. The independent relation between BP and each of the three major determinants (age, height, and weight) was nonlinear over the age range studied. Sex-specific regression models with linear terms for age, height and weight were developed for each of four age groups (3-9, 10-14, 15-19, 20-24 years). The 5th, 10th, 90th, and 95th percentiles based on the percentage of predicted values can serve as the cutoffs for low, normal-low, normal-high, and high BP. The predicted values were derived from the above regression models that take into account an individual's sex, age, height, and weight.

CONCLUSIONS

This analysis provided important basis for classification of hypertension status and subsequent investigation of environmental risk factors in this population.

X-ray and molecular emission from the nearest region of recent star formation

The isolated, young, sunlike star TW Hya and four other young stars in its vicinity are strong x-ray sources. Their similar x-ray and optical properties indicate that the stars make up a physical association that is on the order of 20 million years old and that lies between about 40 and 60 parsecs (between about 130 and 200 light years) from Earth. TW Hya itself displays circumstellar CO, HCN, CN, and HCO+ emission. These molecules probably orbit the star in a solar-system-sized disk viewed more or less face-on, whereas the star is likely viewed pole-on. Being at least three times closer to Earth than any well-studied region of star formation, the TW Hya Association serves as a test-bed for the study of x-ray emission from young stars and the formation of planetary systems around sunlike stars.

Elevated plasma norepinephrine after in utero exposure to cocaine and marijuana

OBJECTIVE

To compare plasma catecholamine concentrations between cocaine-exposed and unexposed term newborns and to determine the relationship between plasma catecholamines and newborn behavior.

METHODS

Forty-six newborn infants participating in a prospective study of the neonatal and long-term effects of prenatal cocaine exposure were studied. Based on maternal self-report, maternal urine screening, and infant meconium analysis, 24 infants were classified as cocaine-exposed and 22 as unexposed. Between 24 and 72 hours postpartum, plasma samples for norepinephrine (NE), epinephrine, dopamine, and dihydroxyphenylalanine analysis were obtained. The Neonatal Behavioral Assessment Scale was administered at 1 to 3 days of age and at 2 weeks of age by examiners masked to the drug exposure status of the newborns.

RESULTS

The cocaine-exposed newborns had increased plasma NE concentrations when compared to the unexposed infants (geometric mean, 923 pg/mL vs 667 pg/mL). There were no significant differences in plasma epinephrine, dopamine, or dihydroxyphenylalanine concentrations. Analysis for the effect of potential confounding variables revealed that maternal marijuana use was also associated with increased plasma NE, although birth weight, gender, and maternal use of alcohol or cigarettes were not. Geometric mean plasma NE was 1164 pg/mL in those infants with in utero exposure to both cocaine and marijuana compared to 812 pg/mL in those exposed to only cocaine and 667 pg/mL in those exposed to neither. Among the cocaine-exposed infants, plasma NE concentration correlated with an increased score for the depressed cluster (r = .53) and a decreased score for the orientation cluster (r = -.43) of the Neonatal Behavioral Assessment Scale administered at 1 to 3 days of age. Adjusting for marijuana exposure had no effect on these relationships between plasma NE and the depressed and orientation clusters.

CONCLUSION

Plasma NE is increased in newborns exposed to cocaine and marijuana. Increased plasma NE is associated with selected neurobehavioral disturbances among cocaine exposed infants at 1 to 3 days of life but not at 2 weeks.

Violence-related injuries in a pediatric emergency department

BACKGROUND

Since the 1980s, violence has emerged as a leading public health concern in the United States. Recent studies have begun to address the impact of interpersonal violence specifically on young children. The purpose of this study was to describe the epidemiology of violence-related injuries (VRI) in an urban pediatric emergency department (ED).

METHODS

A six-month retrospective chart review was conducted. The records of 11,000 patients 17 years of age and younger who were seen in an urban pediatric ED were accessed for VRI. VRI were defined as purposefully inflicted with intent to harm. Patients discharged from the ED with VRI were compared to patients admitted with VRI.

RESULTS

Three hundred seventeen (3%) of patients were categorized as having VRI during the six-month study period. Eighty-three percent were discharged, and 17% were admitted. The majority of injuries was the result of interpersonal conflict with a friend or acquaintance. Patients discharged were more likely to involve: younger children, female victims, and blunt instruments. Thirteen percent of discharged patients, however, involved potentially lethal weapons (knife or firearm).

CONCLUSIONS

The vast majority of patients with VRI are discharged from the ED. Females and young children were frequently evaluated for VRI in the pediatric ED. Identification of these patients can be used to initiate service protocols directed at violence prevention.

Persistence of pediatric post traumatic stress disorder after 2 years

One-hundred and fifty-six children were randomly evaluated at an inner-city juvenile/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. From our original sample of 156 children, 62 met strict criteria for Post Traumatic Stress Disorder (PTSD). Fifty-two of these 62 were successfully recruited and participated in the 2 year re-examination. Each PTSD diagnosis was conferred by the Diagnostic Interview for Children and Adolescents (DICA). From our sample of 52 PTSD children re-examined after 2 years, 17 (32.7%) retained the full PTSD diagnosis, while 67.3% did not meet criteria.

Late dose-response effects of prenatal cocaine exposure on newborn neurobehavioral performance

OBJECTIVE

To determine in a representative sample of full-term urban newborns of English-speaking mothers whether an immediate or late dose-response effect could be demonstrated between prenatal cocaine exposure and newborn neurobehavioral performance, controlling for confounding factors.

METHODS

The Neonatal Behavioral Assessment Scale (NBAS) was administered by masked examiners to a total sample of 251 clinically healthy, full-term infants at 2 days and/or 17 days. Three in utero cocaine exposure groups were defined: heavily exposed (n = 44, > 75th percentile self-reported days of use during pregnancy and/or > 75th percentile of meconium benzoylecognine concentration); lightly exposed (n = 79, less than both 75th percentiles); and unexposed (n = 101, no positive biological or self-report marker). At the 3-week examination there were 38 heavily exposed, 73 lightly exposed, and 94 unexposed infants. Controlling for infant birth weight, gestational age, infant age at the time of examination, mothers' age, perinatal risk, obstetric medication, and alcohol, marijuana, and cigarette use, a regression analysis evaluated the effects of levels of cocaine exposure on NBAS performance.

RESULTS

No neurobehavioral effects of exposure on the newborn NBAS cluster scores or on the qualifier scores were found when confounders were controlled for at 2 to 3 days of age. At 3 weeks, after controlling for covariates, a significant dose effect was observed, with heavily exposed infants showing poorer state regulation and greater excitability.

CONCLUSIONS

These findings demonstrate specific dose-related effects of cocaine on 3-week neurobehavioral performance, particularly for the regulation of arousal, which was not observed in the first few days of life.

Association between child behavior problems and frequent physician visits

OBJECTIVE

To determine the association between parent-reported behavior problems and health care utilization, especially among physically healthy children.

DESIGN

Analysis of data from the 1988 National Health Interviews Survey--Child Health Supplement. The sample for analysis consisted of 11,840 children aged 5 to 17 years. The independent measure of primary interest are behavior problems as measured by the Behavior Problems Index. For the bivariate analysis, children in the lowest quartile, highest quartile and middle half were compared. For the multivariate analysis, children in the highest quartile with behavior problems were compared with all other children.

MAIN OUTCOME MEASURES

The number of reported physician visits in the past year and the past 2 weeks, Two common behavior syndromes--antisocial and depressed or anxious--were analyzed separately to determine whether a specific type of behavior problem was associated with frequent health care utilization.

RESULTS

Eighteen percent of the children aged 5 to 17 years had four or more health visits during the past year, and 2% had two or more visits during the past 2 weeks. Children in the top quartile for parent-reported behavior problems were more likely to have four or more physician visits than children in the middle half and bottom quartile. Children reported to be in "excellent," "very good," or "good" health who were in the top quartile of behavior problems were more likely to report four or more physician visits during the past year, but no statistically significant differences were seen among children reported to be in "fair" or "poor" health. Controlling for confounding variables, children in the top quartile of the Behavior Problems Index are significantly more likely to report four or more visits during the past year and two or more visits during the past 2 weeks compared with other children. Anxious or depressed and antisocial subscales of the Behavior Problems Index showed independent and significant associations with four or more physician visits in the past year.

CONCLUSION

Children with parent-reported behavior problems are likely to have more frequent physician visits compared with children without behavior problems, even when confounding sociodemographic and health status variables are controlled. The association is concentrated among physically healthy children.

Familial aggregation of low birth weight among whites and blacks in the United States

BACKGROUND

Studies have shown that the birth weight of infants is correlated with the birth weights of their siblings and their mothers. We investigated whether the birth weights of mothers and index children were jointly associated with the risk of low birth weight in the siblings of the index children.

METHODS

We used data on the live-birth cohort of the 1988 National Maternal and Infant Health Survey. The analysis included 1691 white and 1461 black mothers, each of whom had two or more live-born, singleton children. Multiple logistic regression with generalized-estimation equations was used to assess the risk of low birth weight among an index child's siblings. Four groups were studied: that in which neither the mother nor the index child had low birth weight (group 1), that in which only the mother had low birth weight (group 2), that in which only the index child had low birth weight (group 3), and that in which both the mother and the index child had low birth weight (group 4). There was adjustment for other maternal and infant covariates.

RESULTS

Among white siblings in groups 1, 2, 3, and 4, 3.6, 8.3, 21.2, and 38.9 percent, respectively, had low birth weight, as compared with 8.0, 19.0, 31.1, and 57.1 percent of black siblings. When group 1 was used as the reference group, the adjusted odds ratios (and 95 percent confidence intervals) for low birth weight in groups 2, 3, and 4 were 2.5 (1.4 to 4.3), 6.8 (4.7 to 9.8), and 15.4 (9.2 to 25.5), respectively, among white siblings and 2.6 (1.8 to 3.8), 4.7 (3.5 to 6.4), and 13.9 (9.2 to 20.9) among black siblings. These associations were consistently found for birth weights below 1500 g and those ranging from 1500 to 2499 g in both races and after stratification for the mother's age, parity, education, cigarette-smoking status, and weight and height before pregnancy and the infant's sex.

CONCLUSIONS

Although selection and recall biases cannot be excluded with certainty, our data suggest a strong familial aggregation of low birth weight among both whites and blacks in the United States.